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Monday, September 1, 2008

A “LIGHT” Era in Dental Hygiene — The Use of Lasers in Hygiene

By Jeanne Godett, RDHEF

The use of lasers and laser calculus detecting probes in my hygiene practice has shed a new “light” on the possibilities for improved patient care. Because of these technological advances, my job as a hygienist has never been more exciting and rewarding on a daily basis.

One exciting innovation is the DIAGNOdent® Perio Probe, a new laser tool that can detect calculus that cannot be seen or felt by standard root planing and scaling. Since calculus fluoresces differently than healthy tooth structure, this device’s laser emitted from the end of the perio tip not only detects deposits, it then sends a quantifying signal to the display indicating that calculus has been found.

For some patients, this new technology offers renewed hope for treatment they had to forego previously because of other health concerns. One patient’s story illustrates the success that we have achieved by implementing this technology. Our 32-year-old female patient reported a clean health history. BCP was the only medication, no known allergies, no recent illness, surgeries and/or hospitalizations, no artificial joints, valves, or prosthetics. Her blood pressure was 110/81, pulse 87. She did indicate, however, a family history of diabetes. Her lower left molar had chipped, and part of her restoration had fallen out. A periapical X-ray was taken along with a bitewing X-ray. The examination indicated that the patient had periodontal disease and the foundation for a permanent restoration was in jeopardy. “Laser light” came to the rescue in this complicated case. The tooth was prepped and temporized while the periodontal infection was treated.

We treated the upper left quadrant first due to the severity of the infection present, after placing anesthetic into the vestibule. We detected calculus in this quad by using the Perio Probe and removed the calculus using micro-ultrasonics, hand instrumentation, and then repeated micro-ultrasonics. Because of the bactericidal properties of the diode laser in the periodontally infected pocket and its ability to decrease the pathogenic microbial population, we completely disinfected the whole mouth using the GENTLEray® 980 laser prior to any treatment. After reprobing and getting no calculus readings on the Perio Probe, we removed the diseased and infected epithelial lining and restored the tissues to health. Because the diode laser has an affinity for melanin and hemoglobin, we were able to selectively remove the diseased epithelium and disinfect the pocket, leaving only the healthy tissues to rebuild. The upper left quadrant had 8 mm pockets on the distobuccal of Tooth No. 14 and mesiobuccal of Tooth No. 15. These pockets were treated with Arestin® (LAA) and retreated in 21 days. Only the laser was used to decontaminate these sites. The patient then returned at two-week intervals for retreatment of the infected sites throughout the mouth until disease remission was achieved. After three months, the patient returned for a reevaluation appointment and full-mouth reprobe. Although there was more bleeding than I would have liked, the pocket resolution was incredible. The only area that needed retreatment was the distolingual of Tooth No. 32. Arestin was applied in this area to maintain health until third molars are extracted. We advised the patient to have a physical evaluation and be tested for diabetes. The patient’s home care included a Sonicare® toothbrush, CloSYS™ toothpaste and mouthrinse, along with daily use of Johnson & Johnson REACH® access™ flosser and tongue scraper. She was placed on a 12-week bacterial load monitoring interval, to be adjusted as necessary to maintain health.

This is just one example of the success that we have experienced with our new laser technology. As a hygienist, I am grateful to the out-of-the-box thinkers and inventors of these laser and probe products that help treat infection. Those of us who have the pleasure of using lasers are witnessing bone regeneration and health improvement for our patients. We can now watch tissues heal.

As one of the clinical instructors in the comprehensive hygiene course at the Las Vegas Institute, I am privileged to work with hygienists from all over the country and expose them to the latest technology in laser and probe products. Laser technology has ignited a light from within, putting excitement back into my career.

Jeanne Godett, RDHEF, has been making a professional difference in people’s lives for more than 25 years. Her insatiable desire for continuous improvement in her professional skills has taken her from a proficient RDA, to the UCLA School of Dentistry’s RDAEF certification, and on to an RDH degree from San Joaquin Valley College in Visalia, becoming the 17th RDHEF within the state of California. Jeanne’s focus on providing the best patient care at the highest level of value-added services for the practice led her to expand into the area of consulting. She routinely meets with hygienists throughout the United States and Canada providing instruction, guidance, and productivity guidelines related to hygiene and the use of lasers. Today, she is also the director of LVI Global’s laser program and clinical instructor for their comprehensive hygiene program. Jeanne is able to share the knowledge she has gained over the years to many new and revitalized members of the dental profession. For more information on the LVI comprehensive hygiene or laser certification courses, please contact: LVI @ (888) 584-3237 or www.lviglobal.com. You may contact Ms. Godett at jghygiene@aol.com.

More than likely you understand that surrounding yourself with a good team greatly improves your chances of success. In your office the members of this team can include dental assistants, hygienists, lab technicians, office managers, and various other staff personnel. In addition, your business team typically includes an accountant, an attorney, and in many cases, a practice management consultant.
The question is: Would you ask your hygienist for tax-saving strategies? Or, would you seek the advice of your accountant for ways to improve procedure acceptance rates? Probably not. And, the reason for this is simple. A team member’s expertise in one area does not necessarily translate into another. That is why, when analyzing the optimal size and layout of the office, the best way to finance a project is to restructure your existing debt, or simply determine how much debt you can afford. The best practice is to engage the services of experts who specialize in dental office design and commercial finance. Do not let your loyalties, or the egos of existing team members sway you from seeking expert advice.
Here’s an example. A Finance Geeks client was recently offered financing from two separate lenders to finish out a new leased office space. After reviewing the information with his accountant, he was advised to move forward with the 7-year loan versus a loan of 15 years, simply because the interest rate was 1.50% lower. When the client suggested that the resulting cash flow would be tight because of the higher debt payments, the accountant advised that he should forego his retirement contributions in order to service the new debt until his practice grew and cash flow sufficiently increased.
What?! Delay retirement contributions?! Delaying a $3,000 per month retirement contribution for just 5 years results in over $1,000,000 LESS in a retirement nest egg 20 years later. This is the cardinal sin of wealth creation and can result in the loss of millions at the time of retirement. I am certain that this accountant is very good at what he does. Otherwise, the client would not continue to keep him as part of his team. However, this is a prime example of what can occur when advice is solicited from the wrong expert.
Determining the actual cost of building a dental office and deciding on the correct debt structure are only reasons why you should surround yourself with a team of experts during the office project. To be honest, I could probably list another 50 reasons but they all boil down to one resounding theme: “You don’t know what you don’t know.” Unfortunately, many dentists find this out only after they have accepted advice from the wrong expert or have made numerous mistakes on their own that have cost them several thousands of dollars. In many cases, the doctors will never recover financially.
What is the optimal square footage for your office based on your practice performance? What is the REAL cost of building that office? How much can you afford to borrow for your project? Is it better to lease or own? If building an office, how much land do you require? What are the required set-backs? What is the estimated cost for your office and equipment? What is the financial GAP for your project (and, believe me, you’ll have one)? These questions and more need to be answered before you move forward with your project. Do you know the answers? One of my favorite sayings is “intelligence is no substitute for experience”. If you’ve tended to be successful at everything you have done, you may be at risk for thinking your success in one area will be applicable in another. Expansion projects involve the highly specialized areas of design, construction, real estate and banking. Hiring a team of Experts to take you through the process may be the edge you need to come out on top and will help you avoid the numerous $100,000 mistakes that are possible. For more information on hiring a team of experts to help you explore your options and empower yourself with knowledge BEFORE potentially exposing yourself to enormous financial risk, consider EnviroMed Design Group’s Project Evaluation Service. Click here for more details.